Prof Niro Siriwardena presented CaHRU’s latest study on ‘Clinical effectiveness and costs of prehospital inhaled methoxyflurane for acute pain in trauma in adults: non-randomised control group study’ from Dr Murray D Smith who led the analysis, with Dr Elise Rowan of CaHRU and Rob Spaight of East Midlands Ambulance Service NHS Trust (EMAS), at the Fourth Annual College of Paramedics conference which took place online on 26 November this year.
Methoxyflurane (Penthrox®; Galen Ltd) although widely as an inhalational analgesic in adults and children for over 40 
years in Australia and New Zealand was more recently issued a European licence for emergency relief of moderate to severe pain in conscious adults with trauma pain. The presentation described the implementation and evaluation of methoxyflurane in EMAS using a non-randomised design and statistical/econometric modelling to show the effect of methoxyflurane compared with usual analgesics such as Entonox, intravenous paracetamol or intravenous morphine taking into account patient age, sex, clinical condition, and initial pain score.
The study involved training 96 EMAS clinicians provided 520 doses of methoxyflurane which were then used over the following year for adults with trauma, in place of or in addition to usual analgesics. Methoxyflurane acted more three times more quickly than Entonox or intravenous paracetamol to reduce pain from severe (pain score 7-10) to moderate (pain score 4-6), and more than twice as quickly as intravenous morphine. Both paramedics and EMTs were able to implement the use of methoxyflurane. Clinician reported adverse effects minor and infrequent (6.7%) and benefits were achieved at higher cost. Study limitations related to observational data and methods. The study was conducted independently from the funder, Galen Ltd.
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